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Exercises involving the tongue and soft palate may reduce the severity and symptoms in patients with moderate obstructive sleep apnea (OSA), sleep specialists report in the American Journal of Respiratory and Critical Care Medicine.

OSA is a condition in which the throat muscles collapse during sleep, preventing oxygen from getting to the lungs. These episodes, called "apnea," are followed by loud snoring and labored breathing. The sleeper is eventually aroused from deep sleep as he struggles to breath. This all results in overall poor sleep quality, followed by daytime drowsiness.

A recent study showed that playing the didgeridoo to train the upper airway muscles "significantly ameliorated OSA syndrome severity and associated symptoms," according to principal investigator Dr. Geraldo Lorenzi-Filho and associates at the University of Sao Paulo Medical School in Brazil. A didgeridoo is a wind instrument used by Australian Aborigines consisting of a long thick hollowed-out wooden pipe that makes a deep reverberating sound.

With this in mind, the researchers chose a set of isometric and isotonic exercises for the tongue and soft palate area (oropharyngeal area) derived from speech therapy training that involved suction, swallowing, chewing, breathing and speech. In a clinical trial, 31 patients were randomly assigned to the exercise regimen (to be performed for 30 minutes each day for 3 months), or to a sham "deep breathing" therapy.

At the end of 3 months, the average apnea-hypopnea index, the sum of apneas plus hypopneas (episodes of shallow breathing) per hour of sleep, had decreased significantly from 22.4 to 13.7 events per hour in the exercise group. In addition, the Pittsburgh Sleep Quality score improved from 10.2 to 6.9 points, snoring intensity was reduced from "very loud" to "similar to breathing," and Epworth Sleepiness Scale scores dropped from 14 to 8.

Lorenzi-Filho's group also found that neck circumference was reduced from an average of 39.6 cm to 38.5 cm, "suggesting that the exercises induced upper airway remodeling."

By contrast, no significant changes had occurred in the control group, the authors report.

"Our results," Lorenzi-Filho and his team conclude, "suggest that this set of oropharyngeal exercises is a promising alternative for the treatment of moderate OSA."

In an accompanying commentary, Dr. Catriona M. Steele from the University of Toronto summarizes the tasks included in the exercise protocol -- and many of the exercises she dismisses as unlikely to induce muscle change.

However, she believes that balloon inflation (like didgeridoo playing) may change the tone or strength of the underlying musculature, as could the "tongue press-to-palate task."

Future research, she advises, should investigate nasopharyngeal and tongue pressure resistance exercises to see if they can ameliorate upper airway collapsibility during sleep and determine the optimal treatment elements, such as intensity, frequency, and duration.

SOURCE: American Journal of Respiratory and Critical Care Medicine, May 15, 2009.